Eating Disorders: Not Just for Women

They exercise for hours, devise rigid rituals surrounding food, obsessively monitor their weight and yearn to resemble the taut-bodied celebrities whose images grace magazine covers. But the models and actors this group typically emulates are not the skeletal Kate Moss or wispy Nicole Kidman but the chiseled muscularity of soccer superstar David Beckham and actor Daniel Craig, the latest screen incarnation of James Bond.

The reason: These eating disorder sufferers are male.

Long regarded as a women's problem, the trio of serious eating disorders -- the self-starvation of anorexia, the gorging and purging that characterize bulimia and the uncontrolled consumption of large amounts of food that is binge eating -- are increasingly affecting males.

Last month, Harvard researchers reported the results of the first national study of eating disorders in a population of nearly 3,000 adults and found that 25 percent of those with anorexia or bulimia and 40 percent of binge eaters were men.

The authors called the rate "surprisingly high" because earlier studies had estimated that males accounted for about 10 percent of the cases of bulimia and anorexia, which can be fatal. Binge eating is not officially recognized as a psychiatric disorder and is not considered life-threatening, but its prevalence among men surprised some eating disorders specialists.

Although disordered eating is well-known among teenage girls and young women, experts say the problem among boys and young men is frequently overlooked by parents and coaches and under-treated by doctors. Males, they now believe, appear to be vulnerable to social pressures to achieve the perfect body similar to those that have long plagued women. But unlike the female ideal, which tends to focus on a "goal weight" or overall skinniness, men's focus is nearly always on achieving "six-pack" abs.

"Men are more reluctant to admit losing control" about food, said James I. Hudson, lead author of the study, which estimated that about 9 million Americans suffer from an eating disorder at some point in their lives. The research was published last month in the journal Biological Psychiatry.

Stigma, Hudson added, remains a major barrier: Many men are loath to admit having a problem that is so strongly associated with women, fearing they will seem unmanly. Even if they do, they may have trouble finding treatment: Some eating disorder programs admit only women.

And in sharp contrast to the parade of female celebrities who have publicly discussed their eating disorders, few well-known men have come forward.

The most notable exception is actor Dennis Quaid, who has talked about his battle with what he termed "manorexia," for which he sought treatment. Quaid said his problem started when he lost 40 pounds to play Doc Holliday in the 1994 movie "Wyatt Earp." Actor Billy Bob Thornton has said he, too, has battled anorexia, at one point losing 59 pounds, and singer Elton John has said he suffered from bulimia. Former male model Ron Saxen has written a new book describing his ordeal with binge eating.

Some men have suffered from all three. Among them is Matt Gaebel, 22, who was hospitalized for anorexia during his sophomore year at North Carolina State University after his weight plummeted from 155 to 106 pounds. Gabel, who is 6 feet 3 inches tall, said he subsequently developed bulimia to cope with the weight he gained during treatment for anorexia, then turned to binge eating out of concern that self-induced vomiting would ruin his teeth.

Binge eating, said Gaebel, who lives with his parents in Cary, N.C., "calms me down." It has also left him feeling fat as well as "very isolated and depressed"; he now weighs 225 pounds.

Isolation is not a new feeling. Gaebel said he was the only male eating disorder patient most of the months he was hospitalized at the University of North Carolina. The only male he met there, he said, was a very young boy struggling with his homosexuality. Gaebel said he worried that people might erroneously think he was gay, because male homosexuality is associated with the development of eating disorders. (Experts say the increased risk is not intrinsic, but stems from the emphasis on weight and appearance among gay men.)

"I really didn't have anyone to talk to," Gaebel recalled. Although not overweight when he developed anorexia, he had been teased in middle school for his "baby fat" and "love handles." Such experiences are common among men with eating disorders, said psychologist Cynthia Bulik, director of UNC's eating disorders program.

Psychiatrist Arnold Andersen, director of the eating disorders program at the University of Iowa and a widely recognized expert on male eating problems, said he has treated teenagers who developed bulimia or anorexia after failing to make a sports team where weight is paramount, such as wrestling.

Other patients include men who began dieting to meet job requirements -- and couldn't stop. "We've had a number of military people like colonels," said Andersen, who was formerly on the staffs of Johns Hopkins Hospital and the National Institutes of Health. "The military is very strict, and they're afraid they're going to get chucked out" or fail to win a promotion if they don't lose weight to meet certain requirements.

Adelaide Robb, associate professor of psychiatry at George Washington University School of Medicine, said that many of the risk factors for males are the same as for females, although boys are more likely to be overweight and are typically older than girls when they develop an eating disorder.

In both sexes there is often a family history of eating disorders -- Gaebel said that is true in his family -- as well as perfectionist and obsessive behaviors and a history of dieting.

Treatment for males and females involves cognitive therapy to overcome a distorted body image, which is at the core of eating disorders. Depression and substance abuse may also be present.

Parents of boys, Robb said, are much less likely to recognize the problem and more apt to deny it. Pediatricians, she said, often don't suspect it, either.

"Boys say, 'I'm getting into shape,' " Robb said, "not, 'I'm fat and gross and need to go on a diet,' " as do girls. Initially, she added, many parents are thrilled that their teenage son who could polish off huge quantities of food in short order has sworn off junk food, carbohydrates or pizza in favor of turkey sandwiches, broiled salmon and fruit. "They often think he's adopted healthy eating habits."

"A teenage boy shouldn't be eating what his 110-pound, dieting mother would eat," Robb cautioned. "It's normal for a half-gallon of milk and a loaf of bread to disappear every 48 hours if there's a teenage boy in the house." A notable change in eating habits, she noted, should prompt a call to a physician or nutritionist.

Parents, Robb said, should model healthy behavior and avoid lamenting how chubby they are or trying to run a "fat-free" household. "When parents are hung up on their own weight issues, their kids are at higher risk," she said. "Boys can be as susceptible as girls."

Eating disorders, Robb and other experts say, appear to be caused by a combination of genetic and environmental factors.

"Genes load the gun, and environment pulls the trigger," said North Carolina's Bulik. "But one of the problems I see for male eating disorder patients is just being taken seriously." ·